The diagnostic accuracy of fine-needle aspiration cytology for thyroid nodules is not affected by coexistent chronic autoimmune thyroiditis: results from a cyto-histological series of patients with indeterminate cytology

in European Journal of Endocrinology
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  • 1 Laboratory for Endocrine Disruptors, Unit of Internal Medicine and Endocrinology, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
  • | 2 Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
  • | 3 Unit of Internal Medicine, Medical-Oncologic Department, ASST Lodi, Lodi, Italy
  • | 4 Department of Clinical and Experimental Sciences, SSD Medicina ad indirizzo Endocrino-metabolico, University of Brescia, ASST Spedali Civili di Brescia, Brescia, Italy
  • | 5 PhD Course in Experimental Medicine, University of Pavia, Pavia, Italy
  • | 6 Department of Medicine and Surgery, University of Salerno, Fisciano, Italy
  • | 7 Postgraduate School in Endocrinology and Metabolism, University of Pavia, Pavia, Italy
  • | 8 Istituti Clinici Scientifici Maugeri IRCCS, Pathology Unit, Pavia, Italy

Correspondence should be addressed to L Chiovato Email luca.chiovato@icsmaugeri.it
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Objective

Indeterminate cytological result at fine-needle aspiration cytology (FNAC) remains a clinical challenge for endocrinologists. Aim of the present study was to evaluate whether a coexistent chronic autoimmune thyroiditis (CAT) might affect the diagnostic accuracy of fine-needle aspiration cytology for thyroid nodules.

Design and methods

A retrospective cohort study was designed including all nodules receiving an indeterminate cytology result (TIR3A or TIR3B) undergoing thyroid surgery and subsequent histological confirmation. Patients were stratified into two groups according to the presence or absence of CAT. The hypothesis to be tested was whether follicular cell alterations induced by CAT might increase the rate of indeterminate cytological results in histologically benign thyroid nodules. Additional control groups were represented by nodules with determinate cytology, either benign (TIR 2) or malignant (TIR5).

Results

One hundred and eighty-nine indeterminate thyroid nodules were included (67 TIR3A and 122 TIR3B). At post-surgical histology, 46 nodules (24.3%) were malignant. No significant differences were observed in the rate of histologically proven malignancy between patients without CAT and patients with CAT in the TIR3B (29.4% vs 32.4%; P = 0.843) nor TIR3A (13.0% vs 11.4%; P = 1.000) nodules. The rate of coexistent CAT was similar between TIR3B and TIR5 nodules harboring PTC at histology (30.4% vs 39.4%, P = 0.491) and between indeterminate nodules and a control group of TIR2 nodules (39.2% vs 37.0%; P = 0.720).

Conclusions

The similar rates of histologically proven malignancy found in cytologically indeterminate nodules in the presence or absence of concomitant CAT would not support that CAT itself affects the diagnostic accuracy of fine-needle aspiration cytology.

 

     European Society of Endocrinology

Sept 2018 onwards Past Year Past 30 Days
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  • 1

    Cibas ES, Ali SZ. The 2017 Bethesda system for reporting thyroid cytopathology. Thyroid 2017 27 13411346. (https://doi.org/10.1089/thy.2017.0500)

    • Search Google Scholar
    • Export Citation
  • 2

    Nardi F, Basolo F, Crescenzi A, Fadda G, Frasoldati A, Orlandi F, Palombini L, Papini E, Zini M & Pontecorvi A et al.Italian consensus for the classification and reporting of thyroid cytology. Journal of Endocrinological Investigation 2014 37 593599. (https://doi.org/10.1007/s40618-014-0062-0)

    • Search Google Scholar
    • Export Citation
  • 3

    Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM & Schlumberger M et al.2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 2016 26 1133. (https://doi.org/10.1089/thy.2015.0020)

    • Search Google Scholar
    • Export Citation
  • 4

    Hegedüs L Clinical practice. The thyroid nodule. New England Journal of Medicine 2004 351 17641771. (https://doi.org/10.1056/NEJMcp031436)

    • Search Google Scholar
    • Export Citation
  • 5

    Lim H, Devesa SS, Sosa JA, Check D, Kitahara CM. Trends in thyroid cancer incidence and mortality in the United States, 1974–2013. JAMA 2017 317 13381348. (https://doi.org/10.1001/jama.2017.2719)

    • Search Google Scholar
    • Export Citation
  • 6

    Rullo E, Minelli G, Bosco D, Nardi F, Grani G, Durante C, Ascoli V. Indeterminate thyroid nodules (TIR3A/TIR3B) according to the new Italian reporting system for thyroid cytology: a cytomorphological study. Cytopathology 2019 30 475484. (https://doi.org/10.1111/cyt.12732)

    • Search Google Scholar
    • Export Citation
  • 7

    Cozzolino A, Pozza C, Pofi R, Sbardella E, Faggiano A, Isidori AM, Giannetta E, Pernazza A, Rullo E & Ascoli V et al.Predictors of malignancy in high-risk indeterminate (TIR3B) cytopathology thyroid nodules. Journal of Endocrinological Investigation 2020 43 11151123. (https://doi.org/10.1007/s40618-020-01200-0)

    • Search Google Scholar
    • Export Citation
  • 8

    Bongiovanni M, Bellevicine C, Troncone G, Sykiotis GP. Approach to cytological indeterminate thyroid nodules. Gland Surgery 2019 8 S98S104. (https://doi.org/10.21037/gs.2018.12.06)

    • Search Google Scholar
    • Export Citation
  • 9

    Brown C, Mangano W, Thompson S, Richmond B. Factors predicting thyroid malignancy in fine needle aspiration biopsy specimens classified as atypia of uncertain significance/follicular lesion of uncertain significance. American Surgeon 2018 84 12071213. (https://doi.org/10.1177/000313481808400740)

    • Search Google Scholar
    • Export Citation
  • 10

    Khoncarly SM, Tamarkin SW, McHenry CR. Can ultrasound be used to predict malignancy in patients with a thyroid nodule and an indeterminate fine-needle aspiration biopsy? Surgery 2014 156 967970. (https://doi.org/10.1016/j.surg.2014.06.043)

    • Search Google Scholar
    • Export Citation
  • 11

    Lastra RR, Pramick MR, Crammer CJ, LiVolsi VA, Baloch ZW. Implications of a suspicious afirma test result in thyroid fine-needle aspiration cytology: an institutional experience. Cancer Cytopathology 2014 122 737744. (https://doi.org/10.1002/cncy.21455)

    • Search Google Scholar
    • Export Citation
  • 12

    McIver B, Castro MR, Morris JC, Bernet V, Smallridge R, Henry M, Kosok L, Reddi H. An independent study of a gene expression classifier (Afirma) in the evaluation of cytologically indeterminate thyroid nodules. Journal of Clinical Endocrinology and Metabolism 2014 99 40694077. (https://doi.org/10.1210/jc.2013-3584)

    • Search Google Scholar
    • Export Citation
  • 13

    Sciacchitano S, Lavra L, Ulivieri A, Magi F, De Francesco GP, Bellotti C, Salehi LB, Trovato M, Drago C, Bartolazzi A. Comparative analysis of diagnostic performance, feasibility and cost of different test-methods for thyroid nodules with indeterminate cytology. Oncotarget 2017 8 4942149442. (https://doi.org/10.18632/oncotarget.17220)

    • Search Google Scholar
    • Export Citation
  • 14

    Mulder MB, Khazeni KC, Sussman MS, Lew JI, Farrá JC. Chronic lymphocytic thyroiditis may lower accuracy of AUS/FLUS cytopathology in surgical patients. Journal of Surgical Research 2020 245 244248. (https://doi.org/10.1016/j.jss.2019.07.068)

    • Search Google Scholar
    • Export Citation
  • 15

    Gao L, Ma B, Zhou L, Wang Y, Yang S, Qu N, Gao Y, Ji Q. The impact of presence of Hashimoto's thyroiditis on diagnostic accuracy of ultrasound-guided fine-needle aspiration biopsy in subcentimeter thyroid nodules: a retrospective study from FUSCC. Cancer Medicine 2017 6 10141022. (https://doi.org/10.1002/cam4.997)

    • Search Google Scholar
    • Export Citation
  • 16

    Hu F, Yan Z, Ma B, Jiang Y, Huang H. The impact of concurrent Hashimoto thyroiditis on thyroid nodule cytopathology assessed by ultrasound-guided fine-needle aspiration cytology. Postgraduate Medicine 2020 132 506511. (https://doi.org/10.1080/00325481.2020.1739462)

    • Search Google Scholar
    • Export Citation
  • 17

    Grani G, Calvanese A, Carbotta G, D'Alessandri M, Nesca A, Bianchini M, Del Sordo M, Vitale M, Fumarola A. Thyroid autoimmunity and risk of malignancy in thyroid nodules submitted to fine-needle aspiration cytology. Head and Neck 2015 37 260264. (https://doi.org/10.1002/hed.23587)

    • Search Google Scholar
    • Export Citation
  • 18

    Rotondi M, Cappelli C, Leporati P, Chytiris S, Zerbini F, Fonte R, Magri F, Castellano M, Chiovato L. A hypoechoic pattern of the thyroid at ultrasound does not indicate autoimmune thyroid diseases in patients with morbid obesity. European Journal of Endocrinology 2010 163 105109. (https://doi.org/10.1530/EJE-10-0288)

    • Search Google Scholar
    • Export Citation
  • 19

    Croce L, De Martinis L, Pinto S, Coperchini F, Dito G, Bendotti G, Pasquali D, Cappelli C, Latrofa F & Magri F et al.Compared with classic Hashimoto's thyroiditis, chronic autoimmune serum-negative thyroiditis requires a lower substitution dose of L-thyroxine to correct hypothyroidism. Journal of Endocrinological Investigation 2020 43 16311636. (https://doi.org/10.1007/s40618-020-01249-x)

    • Search Google Scholar
    • Export Citation
  • 20

    Zeppa P, Cozzolino I, Peluso AL, Troncone G, Lucariello A, Picardi M, Carella C, Pane F, Vetrani A, Palombini L. Cytologic, flow cytometry, and molecular assessment of lymphoid infiltrate in fine-needle cytology samples of Hashimoto thyroiditis. Cancer 2009 117 174184. (https://doi.org/10.1002/cncy.20022)

    • Search Google Scholar
    • Export Citation
  • 21

    Caleo A, Landolfi L, Vitale M, Di Crescenzo V, Vatrella A, De Rosa G, Peluso AL, Zeppa P. The diagnostic accuracy of fine-needle cytology of Hurthle cell lesions; a comprehensive cytological, clinical and ultrasonographic experience. International Journal of Surgery 2016 28 (Supplement 1) S65S69. (https://doi.org/10.1016/j.ijsu.2015.12.049)

    • Search Google Scholar
    • Export Citation
  • 22

    Tuttle RM, Haugen B, Perrier ND. Updated American Joint Committee on cancer/tumor-node-metastasis staging system for differentiated and anaplastic thyroid cancer (eighth edition): what changed and why? Thyroid 2017 27 751756. (https://doi.org/10.1089/thy.2017.0102)

    • Search Google Scholar
    • Export Citation
  • 23

    Straccia P, Rossi ED, Bizzarro T, Brunelli C, Cianfrini F, Damiani D, Fadda G. A meta-analytic review of the Bethesda System for reporting thyroid cytopathology: has the rate of malignancy in indeterminate lesions been underestimated? Cancer Cytopathology 2015 123 713722. (https://doi.org/10.1002/cncy.21605)

    • Search Google Scholar
    • Export Citation
  • 24

    Poller DN, Bongiovanni M, Trimboli P. Risk of malignancy in the various categories of the UK Royal College of Pathologists Thy terminology for thyroid FNA cytology: a systematic review and meta-analysis. Cancer Cytopathology 2020 128 3642. (https://doi.org/10.1002/cncy.22201)

    • Search Google Scholar
    • Export Citation
  • 25

    Crescenzi A, Trimboli P, Basolo F, Frasoldati A, Orlandi F, Palombini L, Papini E, Pontecorvi A, Vitti P & Zini M et al.Exploring the inter-observer agreement among the members of the Italian consensus for the classification and reporting of thyroid cytology. Endocrine Pathology 2020 31 301306. (https://doi.org/10.1007/s12022-020-09636-z)

    • Search Google Scholar
    • Export Citation